Telehealth Use Continues and Receives Further Medicare Payment 

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Since the new year began, this author received many questions about two different, but aligned topics:

1. Will the COVID-19 public health emergency (PHE) end in January 2023?
2. What are the telehealth regulations for 2023?

As we have previously discussed in Business Briefs, President Biden and Department of Health and Human Services (HHS) Secretary Xavier Becerra promised that 60 days’ notice would be provided before declaring an end to the COVID-19 PHE. Because such a notice was not provided in mid-November 2022, and because highly contagious COVID-19 variants continue to spread in the U.S., the country was not surprised when, on January 11, 2023, the COVID-19 PHE was extended for 90 more days.

In case you are curious, this was the 12th extension of the COVID-19 PHE, and contrary to the “rumor mill,” an end date of April 2023 to the COVID-19 PHE has not been determined. If mid-February 2023 passes, and a 60-day notice is not released, the COVID-19 PHE will not end in April 2023. Watch for future announcements from the HHS!

Prior to the COVID-19 PHE, telehealth was not widely used due to restrictive laws and regulations from a variety of agencies. As previously discussed in Business Briefs, once the COVID-19 PHE was declared, many governmental agencies temporarily relaxed their laws and regulations, which allowed many patients to receive some of their healthcare via telehealth. This was a blessing to many patients, including patients with wounds/ulcers who needed assessments but did not need any procedures.

Because no one could have predicted that the COVID-19 PHE would continue for such a long time, the relaxed telehealth laws and regulations had different end dates, some of which have been extended for different time periods. That is why so many wound/ulcer management professionals are asking about the 2023 telehealth regulations.

Therefore, let us review the Medicare telehealth flexibility extensions that may be important to wound/ulcer management professionals. CAUTION: The following information only pertains to Medicare. Check with your state’s policies regarding the end to their telehealth flexibilities.

• The 2022 Consolidated Appropriations Act was signed in March 2022 and extended many of the telehealth flexibilities for an additional 151 days after the PHE expires. Some of the 151-day extensions that may interest wound/ulcer management professionals are:

          o   Telehealth may still be furnished in any geographic area
          o   Telehealth may still be furnished in any originating site, including the patient’s home
 
          o   The services that were temporarily added to Medicare’s list of covered telehealth services will continue to be covered during the 151-day extension, eg:
               §  99221–99223 Initial hospital or observation care
               §  99234–99236 Hospital inpatient or observation care
               §  99304–99306 Nursing facility care initial
               §  99341–99342; 99344–99345 Home or resident visit new patient
               §  99441–99443 Phone evaluation & management (E/M) by physician/qualified healthcare professional
 
          o   The services deemed safe to be performed audio-only may continue during the 151 day extension, eg:
               §  99406–99407 Behavioral change smoking
               §  99441–99443 Phone E/M by physician/qualified healthcare professional
               §  G0406–G0408 Inpatient telephone follow up 15 min
               §  G2211 Complex E/M visit add on
               §  G2212 Prolonged outpatient/office visit
 
          o   Physical therapists and occupational therapists may continue to furnish telehealth services
 
          o   Telehealth claims may continue to be submitted with the place of service code that designates the site where the in-person encounter would normally have occurred
 

• On November 1, 2022, the 2023 Medicare Physician Fee Schedule (MPFS) Final Rule affirmed that the Medicare program would pay for the telehealth flexibilities for an additional 151 days after the PHE ends, as required by the 2022 Consolidated Appropriations Act. In addition, the MPFS Final Rule announced that several services were added to the list of permanently allowed telehealth services:

          o   G0316 Prolonged hospital inpatient or observation care E/M service(s), each additional 15 minutes
          o   G0317 Prolonged nursing facility E/M service(s), each additional 15 minutes
          o   G0318 Prolonged home or residence E/M service(s), each additional 15 minutes
          o   G3002 Chronic pain management and treatment, first 30 minutes
          o   G3003 Chronic pain management and treatment, each additional 15 minutes
 
In addition to Modifier -95 (which should still be appended to telehealth services provided during the COVID-19 PHE), two new telehealth modifiers became effective on January 1, 2023:

          o   -93 can be appended to telehealth services provided by audio-only
          o   -FQ must be appended to allowable audio-only telehealth services
 

• Then came the surprise! The Omnibus Government Spending Package, which was passed at the end of December 2022, further extended the telehealth flexibilities until December 31, 2024. Following are some of the telehealth flexibility extensions that should interest wound/ulcer management professionals:

          o   Telehealth may be furnished in any geographic area until December 31, 2024
          o   Telehealth may be furnished in any originating site, including the patient’s home, until December 31, 2024
          o   Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), physical therapists, and occupational therapists may continue to furnish telehealth services until December 31, 2024
          o   Some telehealth services may be furnished audio-only until December 31, 2024
          o   The telehealth services that already received an extension for 151 days after the end of the COVID-19 PHE are allowed until December 31, 2024.
 
NOTE: The ability to use any non-public facing remote communication platform does not appear to be extended past the end of the COVID-19 PHE. Watch for a notice, from the HHS Office for Civil Rights (OCR), about the need to use HIPAA-compliant telehealth technology.

Currently, the Medicare List of Telehealth Services for 2023 does not display new end dates for the extensions described above.1 In addition, it is unclear whether the telehealth flexibility extensions will apply to the telehealth services (eg, 99349–99350 home or resident visit; 97161–97163 PT evaluation; 97164 PT re-evaluation) that appear on the Medicare List of Telehealth Services with an end-date of December 31, 2023.

Therefore, this author assumes that CMS will have to modify some of the telehealth policies that were finalized in the 2023 MPFS Final Rule, as well as the list of covered telehealth services. Watch for further announcements from Medicare and for an update to the list of covered telehealth services. Those updates should provide an excellent roadmap to the end dates of telehealth services, based upon the Omnibus Government Spending Package. Most important, continue to use telehealth as a tool to conduct medically necessary wound/ulcer management assessments for patients who cannot appear for in-person encounters. Telehealth assessments have the potential of preventing emergency room visits, hospitalizations, or even amputations.

Kathleen D. Schaum is a founding member of the Today’s Wound Clinic editorial advisory board and oversees a consulting business. She can be reached for consultation and questions by emailing kathleendschaum@gmail.com

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